Conditions

Coronary Artery Disease

Atherosclerosis causes plaque to build up inside the coronary arteries, reducing blood flow to the heart and increasing the risk of heart attack

Coronary artery disease, also known as ischaemic heart disease, occurs when atherosclerotic plaque accumulates within the coronary arteries — progressively narrowing the vessels and reducing oxygen delivery to the heart muscle. CAD is the leading cause of heart attack and a major contributor to heart failure and arrhythmias. It can develop silently over decades before producing symptoms, making proactive risk assessment and early investigation essential.

Types of CAD

• Obstructive CAD involves significant luminal narrowing — typically more than 50–70% — that restricts coronary blood flow and causes exertional angina or acute coronary syndrome.
• Nonobstructive CAD is characterised by plaque burden without flow-limiting stenosis, but remains clinically significant: vulnerable plaques can rupture unpredictably, triggering acute myocardial infarction even without prior symptoms. It also encompasses coronary microvascular dysfunction and vasospastic angina, which require specific diagnostic approaches.

Symptoms

CAD frequently progresses without symptoms until a significant event occurs. When symptoms are present, they include exertional chest tightness or pressure (angina), breathlessness, reduced exercise tolerance, and palpitations. Women, diabetic patients, and older adults more often present atypically — with fatigue, nausea, or jaw and back pain — rather than classic chest pain.

Risk Factors

Established cardiovascular risk factors include hypertension, hyperlipidaemia, diabetes mellitus, smoking, obesity, physical inactivity, and a family history of premature coronary artery disease. Chronic inflammatory conditions — including autoimmune diseases and obstructive sleep apnoea — are increasingly recognised as independent contributors to accelerated atherosclerosis.

Diagnosis

Diagnosis begins with cardiovascular risk stratification, resting ECG, and fasting lipid and glucose assessment. Non-invasive imaging includes stress echocardiography or myocardial perfusion imaging to detect ischaemia, and coronary artery calcium (CAC) scoring for early atherosclerosis detection in asymptomatic high-risk patients. CT coronary angiography provides detailed anatomical assessment of plaque burden and stenosis severity. Invasive coronary angiography remains the gold standard where revascularisation is being considered, with fractional flow reserve (FFR) measurement used to assess the haemodynamic significance of borderline lesions.

Treatment

Treatment integrates risk factor modification, cardioprotective medications, and revascularisation where indicated. Statins, antihypertensives, antiplatelet agents, and glycaemic control form the medical foundation for all CAD patients. For flow-limiting coronary stenoses, percutaneous coronary intervention (PCI) — balloon angioplasty with stent placement — restores vessel patency with minimal recovery time. Coronary artery bypass grafting (CABG) is preferred for complex multi-vessel disease, left main stem stenosis, or diabetic patients with diffuse CAD. Optimal medical therapy alone remains appropriate for selected patients with stable nonobstructive disease.

Monitoring & Long-Term Care

CAD requires ongoing specialist follow-up to monitor disease progression, adjust medications, and assess for new symptoms. Repeat functional testing or imaging is indicated when symptoms change or recur. Cardiac rehabilitation — combining structured exercise, education, and risk factor optimisation — significantly reduces mortality and improves quality of life following a cardiac event.

Concerned about chest pain, cardiovascular risk, or a recent cardiac diagnosis? Dr. Peter Chang consults at Paragon Medical Centre, Orchard Road. Book a specialist assessment today.